Pandemic is Near?

[croaker260]

FYI everyone. Please take any extra precautions you need and rigorous handwashing. This is ramping up today in the national media about the potential for pandemic. This influenza strain has reported killed 60 in Mexico, all aged from 25 to 45 (our age range, not the elderly....). Fortunately no deaths reported in the US cases, but its here. The CDC is advising it is probably too late for containment, but encourage our standard use of universal precautions.

Lets be safe out there.

Below is a post from the NEMSMA list serve

The National EMS Management Association is grateful to the EMS Chiefs of Canada for taking a leadership role in helping EMS agencies prepare for the possibility of a pandemic. As the North American Country with the most contemporary experience with severe respiratory illness outbreaks, Canada is the rightful leader of this effort. NEMSMA is also honored to be allowed to serve as Secretariat and to participate in the process, along with NAED and FirstWatch.

Further updates will be provided periodically as planning continues.

Permission to redistribute this message is granted and encouraged, as long as the message stays in substantially the same form, recognizing the EMS Chiefs of Canada as the lead and the National EMS Management Association, the National Academies of Emergency Dispatch and FirstWatch as collaborators.

NEMSMA members that participate in the NEMSMA Google Group will receive personal messages as well as our posts to the Google Group. Sorry for the duplication, but we believe this information needs to be widely distributed. NEMSMA members and others in the US with information or resources to share with other members and as inputs to our process with EMSCC should direct correspondence to Aarron Reinert, NEMSMA liaison to EMSCC, at aarronr@lrems.com.

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URGENT NEWS UPDATE

Flu Outbreaks in Mexico Linked to Canada and the United States

Best Practices for EMS Agencies Identified by EMS Chiefs of Canada

April 25, 2009

A recent outbreak of the flu in Mexico has been linked to cases of flu in Canada and the United States by the World Health Organization. The EMS Chiefs of Canada are leading a process to identify and disseminate key strategies for EMS organizations to implement to protect their paramedics and to be public health partners in managing the care of the sick.

This is the second time the EMSCC’s Membership Services Committee has coordinated a national teleconference series during outbreaks, the first was for the 2003 SARS outbreak. Lessons learned by Toronto EMS from the SARS outbreak in 2003 demonstrate the critical period for the outbreak will continue until the end of May. Select international agencies were invited to attend yesterday’s EMSCC national discussions for the first time. The National EMS Management Association, FirstWatch and the National Academies of Emergency Dispatch are participating in EMSCC’s process.

There are a number of strategies that EMS agencies should put in place to identify potential victims, protect their paramedics, provide excellent patient care and participate in the public health process. EMSCC will continue to facilitate national discussions between its members and guests until the event is concluded; continuing to identify trends, sharing best practices and disseminating information to the EMS community at large. Individual agencies are asked to share their experiences, policies, procedures and other relevant information through their respective organization.

A conference call led by EMSCC yesterday revealed the following practices being implemented. Reference documents will be made available soon.

By Administrators:

• Notification to staff of the emerging problem.
  
• Reviewing and updating local plans.
  
• Daily communication with hospitals and public health departments.
  
• Monitoring news reports and government resources, such as:
  

  
  

• the Public Health Agency of Canada (www.publichealth.gc.ca)
  
  
• the Centers for Disease Control (www.cdc.gov)

  
  

www.pandemicflu.gov

www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0424a1.htm

www.cdc.gov/flu/swine/recommendations.htm

By Paramedics:

• Requesting more information from dispatchers when sent to respiratory, sick person and fever related calls if limited initial information is provided upon dispatch.
  
• Initial interrogation of the patient from at least 2 meters (6.5 feet) away to determine if personal protective equipment precautions are necessary.
  
• Recommended PPE for taking care of ill/potentially infected patients includes: disposable gowns, gloves, goggles/face shields and N95 or better respirators. PPE should be donned and doffed according to published guidelines to prevent cross contamination, including eye and gown protection when splash or airborne contamination is possible.
  
• Placing a mask on all patients with suspected symptoms, using filtered oxygen masks when available, or non-rebreather masks when oxygen is required. Droplet producing procedures should be avoided whenever possible including nebulizers, bag-valve-mask, suctioning or intubation. If bag-valve-masks are needed, use those with HEPA filters whenever possible.
  
• Alert receiving hospital personnel of the possibility of an infectious patient as soon as possible and hold suspected infectious patients in the ambulance until their destination in the hospital is known, rather than immediately moving them into the emergency room.
  
• Perform a thorough cleaning of the stretcher and all equipment that has come in contact with or been within 2 meters (6.5 feet) with an approved disinfectant, upon completion of the call.
  
• 
  

By Dispatchers:

• When using ProQA software flagging MPDS protocols 6, 10, 18 and 26 for further interrogation, and using the drop down SRI (severe respiratory infection [flu-like] symptoms) screen to obtain, at a minimum, the following:
  
  
• Have they recently been in Mexico or been exposed to anyone that has been in Mexico, and how long the person was in Mexico (paying particular attention to those who stayed for 7 days or longer)?
  
• Are they febrile or have a fever, and if so, is it higher than 38° C (101°F)?
  
• Do they have a cough or any other respiratory symptoms like difficulty breathing?
  
• For dispatch centers not using ProQA software (paper-based cards only), gathering the above information from all callers on protocol cards 6, 10, 18 and 26.
  
• For dispatch centers not using cards or software, include the questions above when the caller reports flu, breathing difficulty or fever.
  Dispatchers should report the responses to these questions to the paramedics before they arrive on the scene.
  

The worst cases of flu that have presented so far have been mostly adults from ages 25 to 45, but patients of all ages have been infected, so the same precautions should be used for all patients.

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The Emergency Medical Services Chiefs of Canada/Directeurs des services medicaux d’urgence du Canada (EMSCC/ DSMUC) is a National organization led by Chiefs and Directors of Canada’s EMS services across the country. The goal of the EMSCC is to advance and align emergency medical leadership across Canada. More information is available at www.emscc.ca.

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The NAED is a national arm of the International Academy of Emergency Dispatch (IAED): a non-profit, standard-setting organization promoting safe and effective emergency dispatch services worldwide. Comprised of three allied Academies for medical, fire and police dispatching, the NAED supports first responder-related research, unified protocol application, legislation for emergency call center regulation, and strengthening the emergency dispatch community through education, certification and accreditation. Since 2003, the IAED has been working through its CBRN Committee to define and improve ways to capture information for calls related to chemical, biological, radiation, nuclear, and severe respiratory. More information is available at www.emergencydispatch.org

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The National EMS Management Association represents 1,600 EMS management professionals and is dedicated to continually improving the care delivered to EMS patients by discovering, developing, and promoting the best EMS management practices. More information is available at www.nemsma.org. NEMSMA has offered to be the secretariat to the EMSCC National Outbreak Discussion Group. In return, meeting minutes and resource source lists will be distributed to our members.

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FirstWatch is commercial-off-the-shelf (COTS) software that enables real-time Dashboard views and data analysis for statistically significant trends, patterns or geographic clusters of incidents, based on user-defined criteria – from a Situational Awareness, Public Health, Operational or Homeland Security standpoint. FirstWatch analyzes real-time data from 9-1-1 (EMS, Fire and Police) CAD systems, ProQA, Paramedic ePCR’s, Hospital Emergency Departments, Hospital Diversion systems, Poison Control Centers and more - in real time, automatically. Chosen by agencies in 85+ metro areas across the US and Canada, representing more than 61,000,000 citizens. Learn more online at: www.firstwatch.net.

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National EMS Management Association

PO Box 927812

San Diego, CA 92192

Edited April 25, 2009 by croaker260

[mobey]

I just wrote a paper on SARS and did alot of research into flu's. According to history we are in for another pandemic (forget epidemic) within the next 5 years.

Could this be it?

BTW: I think this may be a good time to discuss PPE.

I for one have NEVER put on gown and mask for a Resp patient with a fever...... Hmmmm

I have however put a mask on a patient with a fever and having seizures.

Can you believe the Spanish flu killed over 50 million people worldwide

Edited April 25, 2009 by mobey

[tniuqs]

Can you believe the Spanish flu killed over 50 million people worldwide

Yes and as a side bar ... Spanish Flu was responsible for ending WW 1.

Back on topic .. EMS Chiefs may be having (although good advice for any and all possible contact with any patient with increased temp) a bit of a knee jerk, we so missed the Boat with SARS in EMS.

Just checked the Public Health Agency of Canada (PHAC)

http://www.phac-aspc.gc.ca/alert-alerte/h1...n_swine-eng.php

The sky is not falling just yet .

cheers

[TDP]

Certainly won't be the last pandemic. Atleast I don't think.

[Redcell19512]

The media keeps mentioning the deaths in Mexico were not the very young or the very old. I haven't seen anything about the health of these people? Did they have chronic health problems? Were they impoverished with no access to medical care? Did they actually die from a seconday bacterial infection as a result of not obtaining medical care? 60 deaths and about 1000 reported sick. Sounds like a pretty high mortality rate. But how many people in Mexico are/were sick with mild flu like symptoms but recovered or are recovering and never sought medical attention or were off the radar. It's quite possible that there are/were tens of thousands of Swine Flu cases in Mexico. No one really knows. So far all the known cases in the US have been mild with only one person requiring a hospital stay (she was apparently discharged and doing well without antiviral drugs). The whole thing is a little scary. Of course we've had it pounded into our heads for several years now that "the big one" is coming and we're all royally screwed! It's too early to tell I guess. We'll see.

On the issue of EMS providers taking proper precautions...I always wear a face mask when I'm treating patients who are vomiting and also pt's with a fever and cough. I wash my hands after every call and before every meal. I decon my stretcher after every single patient contact (to me this is a no brainer..who wouldn't do this?) I do not use the station utensils when I eat, I keep my own supply of plastics in my locker (our kitchen facility is disgusting...the sink smells like a friggin sewer). I have a speical area at home where I change out of and store my dirty work clothes...they are laundered separate from our normal clothing. As a result, my co-workers have labeled me a "germaphobe" and an "obessive-compulsive freak". I know for a fact that many of my co-workers DO NOT even wash their hands after they use the bathroom! The issue of annual influenza vaccines is another story all together....sigh. So I think we might be in trouble on the PPE front...hopefully it's a local problem for me and not an industry wide problem.

I read an interesting article on the Spanish Flu. There are some researchers who believe the death rate was so high because many if not most of the dead were infected with TB thus increasing their mortality. The theory behind this is that in the year after the outbreak the TB infection rate declined dramatically and continued to do so as did the TB death rate.

[tniuqs]

As things progress here, it is now looking that this could become another wake up call ... I certianly hope that the things we learned from SARs will be applied .... I just wonder why EMSCC are getting acolades as the real experts advice should be Infectious Disease Control or HERT whatever, I have had dealings with this group and some have seriously lost the "reality" of the field applications, never the less, I have quoted this good advice again. I have seen EMSCC talk the talk but many times don't walk the walk, maybe there getting more proactive.

Requesting more information from dispatchers when sent to respiratory, sick person and fever related calls if limited initial information is provided upon dispatch.

Initial interrogation of the patient from at least 2 meters (6.5 feet) away to determine if personal protective equipment precautions are necessary.

Recommended PPE for taking care of ill/potentially infected patients includes: disposable gowns, gloves, goggles/face shields and N95 or better respirators. PPE should be donned and doffed according to published guidelines to prevent cross contamination, including eye and gown protection when splash or airborne contamination is possible.

Placing a mask on all patients with suspected symptoms, using filtered oxygen masks when available, or non-rebreather masks when oxygen is required. Droplet producing procedures should be avoided whenever possible including nebulizers, bag-valve-mask, suctioning or intubation. If bag-valve-masks are needed, use those with HEPA filters whenever possible.

Alert receiving hospital personnel of the possibility of an infectious patient as soon as possible and hold suspected infectious patients in the ambulance until their destination in the hospital is known, rather than immediately moving them into the emergency room.

Perform a thorough cleaning of the stretcher and all equipment that has come in contact with or been within 2 meters (6.5 feet) with an approved disinfectant, upon completion of the call.

Just thought I would highlight some issues that were clearly defined as "weakness" by EMS the last go around, assure that your cleaning agents are anti viral, check your inventory on N 95 and Hepa filters, Swine Flu has been reported in the US already .. and I cancelled my trip to Sunny Mexico with some of the updated stats and reports, but yet again the media has picked this up and will fan the flames.

Observation:

I was sitting in a ambulance bay for 3 hours one day on a "wait and return" and noted on transports Departing and considered Isolation (MRSA) that the driver would do stretcher handling gloved, then hop in the seat gloved, very few actually removed gloves or washed before hopping in the cab (thats is when they removed gloves)

Then:

Ambulances Arriving the Drivers would be gloved but rarely did I not see the Cab being cleaned after the call, maybe the steering wheel got a gentle wipe BUT the Gear Selector, Lights, Door Handles well all I can say is .... ICK!

Being rather Harsh but Honest:

With a background in ICU and with MRSA and VRE outbreaks most EMS providers are extremely poor in this area of isolation and reverse isolation.

It is my hope that if this does become a pandemic that "dirty truck's" and "clean truck" will be established although based on present "Ambulance confusion here in Alberta" the resourses will just not be available to address this situation let alone Ambulance but Hospitals are presently operating with very few beds to spare, IMHO we are no where NEAR prepared for this if it does escalate.

I bet the BS "I have a tooth ache" or "Boo Boo" visits to ER will drop off radically (I would hope) but I have a cough will skyrocket !

Redcell19512

So I think we might be in trouble on the PPE front...hopefully it's a local problem for me and not an industry wide problem.

If your operator is looking to order PPE right now ... well that is just scary.

I will be looking to purchase shares in 3M and Roche

cheers

Edited April 26, 2009 by tniuqs

[JPINFV]

Does anyone know about immigrating to Madagascar?

(for those that don't get it, play this game a few times through. http://www.addictinggames.com/pandemic2.html

[itku2er]

(Click to view this embedded page in a new window)

[ncmedic309]

I just saw that MSNBC is reporting that a school in NY has a possible widespread outbreak of the virus, with well over 100 possible infections. I also saw that Yahoo News is reporting the first two possible deaths from the swine flu in the United States - two men that died in LA County, California. Things are just getting started, this is going to get a lot worse before it gets any better. I give it a couple weeks and we'll start seeing widespread cases throughout the rest of the country.

Edited April 28, 2009 by ncmedic309

[FireMedic65]

a map of where you will die at

http://healthmap.org/swineflu